The Co-Morbidity Burden of Children and Young Adults with Autism Spectrum Disorders

Abstract

ObjectivesUse electronic health records Autism Spectrum Disorder (ASD) to assess the comorbidity burden of ASD in children and young adults.Study DesignA retrospective prevalence study was performed using a distributed query system across three general hospitals and one pediatric hospital. Over 14,000 individuals under age 35 with ASD were characterized by their co-morbidities and conversely, the prevalence of ASD within these comorbidities was measured. The comorbidity prevalence of the younger (Age<18 years) and older (Age 18–34 years) individuals with ASD was compared.Results19.44% of ASD patients had epilepsy as compared to 2.19% in the overall hospital population (95% confidence interval for difference in percentages 13.58–14.69%), 2.43% of ASD with schizophrenia vs. 0.24% in the hospital population (95% CI 1.89–2.39%), inflammatory bowel disease (IBD) 0.83% vs. 0.54% (95% CI 0.13–0.43%), bowel disorders (without IBD) 11.74% vs. 4.5% (95% CI 5.72–6.68%), CNS/cranial anomalies 12.45% vs. 1.19% (95% CI 9.41–10.38%), diabetes mellitus type I (DM1) 0.79% vs. 0.34% (95% CI 0.3–0.6%), muscular dystrophy 0.47% vs 0.05% (95% CI 0.26–0.49%), sleep disorders 1.12% vs. 0.14% (95% CI 0.79–1.14%). Autoimmune disorders (excluding DM1 and IBD) were not significantly different at 0.67% vs. 0.68% (95% CI −0.14-0.13%). Three of the studied comorbidities increased significantly when comparing ages 0–17 vs 18–34 with p<0.001: Schizophrenia (1.43% vs. 8.76%), diabetes mellitus type I (0.67% vs. 2.08%), IBD (0.68% vs. 1.99%) whereas sleeping disorders, bowel disorders (without IBD) and epilepsy did not change significantly.ConclusionsThe comorbidities of ASD encompass disease states that are significantly overrepresented in ASD with respect to even the patient populations of tertiary health centers. This burden of comorbidities goes well beyond those routinely managed in developmental medicine centers and requires broad multidisciplinary management that payors and providers will have to plan for.

Health Conditions and Functional Status in Adults with Autism: A Cross-Sectional Evaluation

“…14,15,33,34 Most notably, we found a considerably higher prevalence of seizure disorders in adults with ASD in all age groups compared to the general population. We also found higher rates of depression, hypertension, and allergies in young adults with ASD, which approached the prevalence of the general population in our older age groups.…”

Comorbidity Clusters in Autism Spectrum Disorders: An Electronic Health Record Time-Series Analysis

“…The prevalence of the comorbidities described in here are higher in the ASD population than in the general pediatric population, even in tertiary care centers, 5 and echo the differences between essential and complex ASDs described by Miles et al 33 Thus, although these co-occurrence patterns may occur for many reasons (a disease, or its treatment, may make the patient more vulnerable for another; genetic variants may have pleiotropic effects that include autism and other comorbidities; and environmental insults may also have pleiotropic effects), we do not believe these findings are simply incidental.…”

“…[1][2][3][4][5] With the prevalence of autism near 1%, 6 understanding this comorbidity burden is especially important (not least because of the clinical resources this burden entails). Understanding the co-occurrence patterns among comorbidities in ASD is the first step for uncovering the underlying etiologies associated with ASD and stratifying the risk of various conditions across individuals with ASD.…”

“…15 However, with the exception of Kohane et al, 5 these studies have involved small samples (under 200 individuals) and have focused on the prevalence of a single disorder. The distinct clinical trajectories of patients with ASD have not been extensively studied, particularly as regards to these comorbidities.…”

The dystrophin gene and cognitive function in the general population

“…[7][8][9][10][11][12] Moreover, a higher incidence of different neuropsychiatric disorders, such as autism spectrum, attention deficit hyperactivity disorder, obsessive-compulsive disorders and social behavior problems has been revealed among affected males. [13][14][15][16][17] The impact of DMD on cognitive ability in cognitively healthy populations has not been studied to the best of our knowledge; therefore, in the current study we aim to investigate whether singlenucleotide DMD variants associate with variability in cognitive functions in general populations, suggesting loci in the DMD contributing to cognition, besides genuine DMD variants.…”